1
|
Deng LH, Jiang H, Lu FL, Wang HW, Pu Y, Wu CQ, Tang HJ, Xu Y, Chen TW, Zhu J, Shen CY, Zhang XM. Size and PEG Length-Controlled PEGylated Monocrystalline Superparamagnetic Iron Oxide Nanocomposite for MRI Contrast Agent. Int J Nanomedicine 2021; 16:201-211. [PMID: 33447035 PMCID: PMC7802780 DOI: 10.2147/ijn.s271461] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 11/10/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE PEGylated superparamagnetic iron oxide (SPIO) is the most promising alternatives to gadolinium-based contrast agents (GBCAs) in MRI. This paper is to explore the imaging effects of PEGylated SPIO, which is influenced by particle sizes and surface polyethylene glycol (PEG) coating, using as MRI contrast agents at different magnetic field intensities. METHODS Firstly, nine PEGylated monocrystalline SPIO nanoparticles with different nanocrystal sizes and different molecular weights PEG coating were prepared, and then physical and biological properties were analyzed. Finally, MRI imaging in vivo was performed to observe the imaging performance. RESULTS Nine PEGylated monocrystalline SPIO nanoparticles have good relaxivities, serum stability, and biosecurity. At the same time, they show different imaging characteristics at different magnetic field intensities. Eight-nanometer SPIO@PEG5k is an effective T 2 contrast agent at 3.0 T (r 2/r 1 = 14.0), is an ideal T 1-T 2 dual-mode contrast agent at 1.5 T (r 2/r 1 = 6.52), and is also an effective T 1 contrast agent at 0.5 T (r 2/r 1 = 2.49), while 4-nm SPIO@PEG5k is a T 1-T 2 dual-mode contrast agent at 3.0 T (r 2/r 1 = 5.24), and is a useful T 1 contrast agent at 0.5 T (r 2/r 1 = 1.74) and 1.5 T (r 2/r 1 = 2.85). MRI studies in vivo at 3.0 T further confirm that 4-nm SPIO@PEG5k displays excellent T 1-T 2 dual-mode contrast enhancement, whereas 8-nm SPIO@PEG5k only displays T 2 contrast enhancement. CONCLUSION PEGylated SPIOs with different nanocrystal sizes and PEG coating can be used as T 1, T 2, or T 1-T 2 dual-mode contrast agents to meet the clinical demands of MRI at specific magnetic fields.
Collapse
Affiliation(s)
- Li-Hua Deng
- Medical Imaging Key Laboratory of Sichuan Province and School of Medical Imaging, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, People’s Republic of China
- Department of Radiology, First People’s Hospital of Neijiang, Neijiang641000, People’s Republic of China
| | - Hai Jiang
- Medical Imaging Key Laboratory of Sichuan Province and School of Medical Imaging, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, People’s Republic of China
| | - Fu-Lin Lu
- Medical Imaging Key Laboratory of Sichuan Province and School of Medical Imaging, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, People’s Republic of China
| | - Han-Wei Wang
- Medical Imaging Key Laboratory of Sichuan Province and School of Medical Imaging, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, People’s Republic of China
| | - Yu Pu
- Medical Imaging Key Laboratory of Sichuan Province and School of Medical Imaging, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, People’s Republic of China
| | - Chang-Qiang Wu
- Medical Imaging Key Laboratory of Sichuan Province and School of Medical Imaging, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, People’s Republic of China
| | - Hong-Jie Tang
- Department of Radiology, Nanchong Hospital of Traditional Chinese Medicine, Nanchong637000, People’s Republic of China
| | - Ye Xu
- Department of Radiology, Children’s Hospital of Chongqing Medical University, Chongqing401122, People’s Republic of China
| | - Tian-Wu Chen
- Medical Imaging Key Laboratory of Sichuan Province and School of Medical Imaging, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, People’s Republic of China
| | - Jiang Zhu
- Medical Imaging Key Laboratory of Sichuan Province and School of Medical Imaging, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, People’s Republic of China
| | - Cheng-Yi Shen
- Medical Imaging Key Laboratory of Sichuan Province and School of Medical Imaging, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, People’s Republic of China
| | - Xiao-Ming Zhang
- Medical Imaging Key Laboratory of Sichuan Province and School of Medical Imaging, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, People’s Republic of China
| |
Collapse
|
2
|
Kim HS, Lee JH, Lee DY, Kim HY, Kim DH, Oh JS, Sin YH, Kim JK, Hwang SD. Allograft dysfunction and parenchymal necrosis associated with renal artery stenosis and perigraft hematoma after kidney transplantation. KOREAN JOURNAL OF TRANSPLANTATION 2020; 34:126-131. [PMID: 35769345 PMCID: PMC9187043 DOI: 10.4285/kjt.2020.34.2.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 04/11/2020] [Accepted: 04/12/2020] [Indexed: 11/21/2022] Open
Abstract
Transplant renal artery stenosis (TRAS) is one cause of allograft dysfunction. TRAS causes parenchymal necrosis and graft insufficiency. Herein, we report the case of a 40-year-old female with end-stage renal disease due to immunoglobulin A nephropathy, who underwent kidney transplantation with her elder sister. The surgery was successful and the allograft showed primary graft function. At postoperative day (POD) 2, urine output decreased sharply. We checked a non-enhanced abdominal computed tomography scan which showed subcapsular and pelvic cavity hematomas. She underwent hematoma removal surgery with renal upper polar capsulotomy. Bleeding control was successful, but her serum creatinine was 5.4 mg/dL. At POD 25, abdomen magnetic resonance angiography showed significant stenosis at the anastomosis site between the graft renal artery and the recipient’s internal iliac artery. Then, percutaneous transluminal angioplasty was implemented. Significant stenosis (>80%) was detected at the anastomotic site and a 5-mm stent was inserted at stenotic lesion with post-stent balloon angioplasty using a 5-mm balloon catheter. The renal arterial diameter and blood flow were normalized. At postoperative 5 months, a 99mTc dimercaptosuccinic acid scan showed multiple focal radioisotope defects. At 54 months after renal transplantation, her serum creatinine level was 4.0 mg/dL and her glomerular filtration rate was 13 mL/min/1.73 m2. Hence, we report that TRAS can cause parenchymal necrosis and allograft dysfunction.
Collapse
Affiliation(s)
- Han Sae Kim
- Department of Internal Medicine, Q Hospital, Busan, Korea
| | - Jin Ho Lee
- Department of Internal Medicine, Bongseng Memorial Hospital, Busan, Korea
| | - Dong Yeol Lee
- Department of Internal Medicine, Bongseng Memorial Hospital, Busan, Korea
| | - Hee Yeoun Kim
- Department of Internal Medicine, Bongseng Memorial Hospital, Busan, Korea
| | - Dong Han Kim
- Department of Internal Medicine, Bongseng Memorial Hospital, Busan, Korea
| | - Joon Seok Oh
- Department of Internal Medicine, Bongseng Memorial Hospital, Busan, Korea
| | - Yong Hun Sin
- Department of Internal Medicine, Bongseng Memorial Hospital, Busan, Korea
| | - Joong Kyung Kim
- Department of Internal Medicine, Bongseng Memorial Hospital, Busan, Korea
| | - Seun Deuk Hwang
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| |
Collapse
|
3
|
Wu C, Yang L, Chen Z, Zhang H, Li D, Lin B, Zhu J, Ai H, Zhang X. Poly(ethylene glycol) modified Mn2+ complexes as contrast agents with a prolonged observation window in rat MRA. RSC Adv 2017. [DOI: 10.1039/c7ra09975d] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PEGylated Mn2+ complexes show higher relaxivity and longer blood circulation time than free Mn2+ complexes.
Collapse
Affiliation(s)
- Changqiang Wu
- National Engineering Research Center for Biomaterials
- Sichuan University
- Chengdu 610064
- P. R. China
- Sichuan Key Laboratory of Medical Imaging
| | - Li Yang
- National Engineering Research Center for Biomaterials
- Sichuan University
- Chengdu 610064
- P. R. China
| | - Zhuzhong Chen
- PET/CT of Imaging Department
- Sichuan Cancer Hospital
- Chengdu 610064
- P. R. China
| | - Houbing Zhang
- National Engineering Research Center for Biomaterials
- Sichuan University
- Chengdu 610064
- P. R. China
| | - Danyang Li
- National Engineering Research Center for Biomaterials
- Sichuan University
- Chengdu 610064
- P. R. China
| | - Bingbing Lin
- National Engineering Research Center for Biomaterials
- Sichuan University
- Chengdu 610064
- P. R. China
| | - Jiang Zhu
- Sichuan Key Laboratory of Medical Imaging
- Department of Chemistry
- North Sichuan Medical College
- Nanchong 637000
- P. R. China
| | - Hua Ai
- National Engineering Research Center for Biomaterials
- Sichuan University
- Chengdu 610064
- P. R. China
- Department of Radiology
| | - Xiaoming Zhang
- Sichuan Key Laboratory of Medical Imaging
- School of Medical Imaging
- North Sichuan Medical College
- Nanchong 637000
- P. R. China
| |
Collapse
|
4
|
Chen W, Kayler LK, Zand MS, Muttana R, Chernyak V, DeBoccardo GO. Transplant renal artery stenosis: clinical manifestations, diagnosis and therapy. Clin Kidney J 2014; 8:71-8. [PMID: 25713713 PMCID: PMC4310434 DOI: 10.1093/ckj/sfu132] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 11/13/2014] [Indexed: 01/04/2023] Open
Abstract
Transplant renal artery stenosis (TRAS) is a well-recognized vascular complication after kidney transplant. It occurs most frequently in the first 6 months after kidney transplant, and is one of the major causes of graft loss and premature death in transplant recipients. Renal hypoperfusion occurring in TRAS results in activation of the renin–angiotensin–aldosterone system; patients usually present with worsening or refractory hypertension, fluid retention and often allograft dysfunction. Flash pulmonary edema can develop in patients with critical bilateral renal artery stenosis or renal artery stenosis in a solitary kidney, and this unique clinical entity has been named Pickering Syndrome. Prompt diagnosis and treatment of TRAS can prevent allograft damage and systemic sequelae. Duplex sonography is the most commonly used screening tool, whereas angiography provides the definitive diagnosis. Percutaneous transluminal angioplasty with stent placement can be performed during angiography if a lesion is identified, and it is generally the first-line therapy for TRAS. However, there is no randomized controlled trial examining the efficacy and safety of percutaneous transluminal angioplasty compared with medical therapy alone or surgical intervention.
Collapse
Affiliation(s)
- Wei Chen
- Department of Medicine , University of Rochester School of Medicine and Dentistry , Rochester, NY , USA ; Department of Medicine , Albert Einstein College of Medicine , Bronx, NY , USA
| | - Liise K Kayler
- Department of Surgery , Albert Einstein College of Medicine , Bronx, NY , USA
| | - Martin S Zand
- Department of Medicine , University of Rochester School of Medicine and Dentistry , Rochester, NY , USA
| | - Renu Muttana
- Department of Medicine , Maimonides Medical Center , Brooklyn, NY , USA
| | - Victoria Chernyak
- Department of Radiology , Albert Einstein College of Medicine , Bronx, NY , USA
| | | |
Collapse
|
5
|
Bultman EM, Klaers J, Johnson KM, François CJ, Schiebler ML, Reeder SB, Block WF. Non-contrast enhanced 3D SSFP MRA of the renal allograft vasculature: a comparison between radial linear combination and Cartesian inflow-weighted acquisitions. Magn Reson Imaging 2013; 32:190-5. [PMID: 24246390 DOI: 10.1016/j.mri.2013.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 09/03/2013] [Accepted: 10/07/2013] [Indexed: 11/20/2022]
Abstract
Renal transplant patients often require imaging to ensure appropriate graft placement, to assess integrity of transplant vessel anastomosis and to evaluate for stenosis that can be a cause of graft failure. Because there is risk for nephrogenic systemic fibrosis in the setting of renal insufficiency, the use of non-contrast MRA in these patients is helpful. In this study, the ability of two non-contrast MRA methods - 3D radial linear combination balanced SSFP (VIPR-SSFP) and inflow-weighted Cartesian SSFP (IFIR) - to visualize the transplant renal vessels is compared. Twenty-one renal transplant patients were scanned using the VIPR-SSFP and IFIR sequences. Diagnostic efficacy of the sequences was scored using a four point Likert scale according to the following criteria: overall image quality, fat suppression, and arterial/venous visualization quality. Average scores for each criterion were compared using the Wilcoxon signed-rank test. In addition to significantly improved venous visualization, the VIPR-SSFP sequence provided significantly improved fat suppression quality (p<0.03) compared to IFIR. VIPR-SSFP also identified several pathologies such as renal arterial pseudoaneurysm that were not visible on the IFIR images. However, IFIR afforded superior quality of arterial visualization (p<0.005). These two methods of non-contrast MR imaging each have significant strengths and are complementary to each other in evaluating the vasculature of renal allografts.
Collapse
Affiliation(s)
- Eric M Bultman
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI.
| | - Jessica Klaers
- Department of Medical Physics, University of Wisconsin, Madison, WI
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin, Madison, WI
| | | | | | - Scott B Reeder
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI; Department of Medical Physics, University of Wisconsin, Madison, WI; Department of Radiology, University of Wisconsin, Madison, WI; Department of Medicine, University of Wisconsin, Madison, WI
| | - Walter F Block
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI; Department of Medical Physics, University of Wisconsin, Madison, WI; Department of Radiology, University of Wisconsin, Madison, WI
| |
Collapse
|
6
|
Onniboni M, De Filippo M, Averna R, Coco L, Zompatori M, Sverzellati N, Rossi C. Magnetic resonance imaging in the complications of kidney transplantation. Radiol Med 2012; 118:837-50. [PMID: 23090252 DOI: 10.1007/s11547-012-0891-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 05/28/2012] [Indexed: 11/28/2022]
Abstract
Kidney transplantation is currently the treatment of choice in most patients with end-stage chronic renal failure owing to the excellent results in terms of both graft and patient survival. However, surgical complications are still very frequent. Although urological (stricture, urinary fistulas, vesico-ureteral reflux) and lymphatic complications (lymphocoele) have a high incidence, they only rarely lead to graft loss. By contrast, vascular complications (stenosis, arterial and venous thrombosis, arterio-venous fistulas, pseudoaneurysms) are relatively rare, but potentially serious and may affect graft survival. Finally, medical complications such as acute tubular necrosis (ATN), rejection and de novo neoplasms may also arise in kidney transplantation. The purpose of this pictorial review is to illustrate the increasingly significant contribution of magnetic resonance angiography (MRA) in the management of complications of kidney transplantation, and emphasise how this method should now be considered a mandatory step in the diagnostic workup of selected cases. Moreover, the application and role in this setting of new magnetic resonance imaging (MRI) techniques, such as diffusion-weighted and blood oxygen level-dependent (BOLD) MRI, are also discussed.
Collapse
Affiliation(s)
- M Onniboni
- Scienze Radiologiche, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, Padiglione Barbieri, 43100, Parma, Italy.
| | | | | | | | | | | | | |
Collapse
|
7
|
Ismaeel MM, Abdel-Hamid A. Role of high resolution contrast-enhanced magnetic resonance angiography (HR CeMRA) in management of arterial complications of the renal transplant. Eur J Radiol 2011; 79:e122-7. [PMID: 21601400 DOI: 10.1016/j.ejrad.2011.04.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 04/11/2011] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Transplant renal artery (RA) stenosis (TRAS) is the most frequent posttransplantation vascular complication. Contrast enhanced magnetic resonance (CeMRA) angiography has been established as the preferred imaging technique for the evaluation of TRAS because it does not require the use of iodinated contrast material and does not expose the patient to ionizing radiation. Digital subtraction angiography (DSA) is the gold standard in the evaluation of arterial tree of the renal allograft. AIM OF THE WORK This study was carried out to assess the accuracy of CeMRA in the detection of arterial complications after renal transplantation. PATIENTS AND METHODS Thirty renal transplant patients with suspected arterial complications in which both CeMRA and DSA were performed were included in the study. The HR CeMRA shows 93.7% sensitivity, 80% specificity, 88.2% positive predictive value, 88.9% negative predictive value and 88.5% accuracy. CONCLUSION HR CeMRA is an accurate reliable tool in the assessment of arterial complications after renal transplantation. It may replace DSA as a diagnostic modality with reservation of interventional techniques for endovascular treatment of suitable cases.
Collapse
|
8
|
Pollard RE, Dayton PA, Watson KD, Hu X, Guracar IM, Ferrara KW. Motion corrected cadence CPS ultrasound for quantifying response to vasoactive drugs in a rat kidney model. Urology 2009; 74:675-81. [PMID: 19589583 DOI: 10.1016/j.urology.2009.01.086] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 01/12/2009] [Accepted: 01/27/2009] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To establish the ability of contrast-enhanced motion corrected cadence pulse sequencing (CPS) to detect changes in renal blood flow induced by vasoactive substances in rats. METHODS Ultrasound contrast media was administered as a constant rate infusion into a phantom at a known rate and CPS data acquired. Rats were anesthetized and predrug CPS estimates of replenishment rate were made for the right kidney. Real-time motion correction was applied, and parametric images were generated from the CPS data. Group 1 rats (n = 7) were administered a vasodilator and group 2 rats (n = 3) were administered a vasoconstrictor. The CPS imaging of the kidney was repeated after ample time for drug effects to occur. RESULTS Contrast CPS accurately estimated flow velocity in the phantom model. In addition, CPS defined statistically significant differences between pre- and postdrug blood flow in the renal medulla (vasodilator, P < .01; vasoconstrictor, P < .0001) and cortex (vasoconstrictor, P < .0001). CONCLUSIONS We conclude that motion-corrected CPS ultrasound provides real-time quantification of renal blood flow alterations and may prove useful for the assessment of blood flow in transplanted kidneys.
Collapse
Affiliation(s)
- Rachel E Pollard
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California 95616, USA.
| | | | | | | | | | | |
Collapse
|
9
|
Liu X, Berg N, Sheehan J, Bi X, Weale P, Jerecic R, Carr J. Renal transplant: nonenhanced renal MR angiography with magnetization-prepared steady-state free precession. Radiology 2009; 251:535-42. [PMID: 19261926 DOI: 10.1148/radiol.2512081094] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The institutional review board approved this HIPAA-compliant study and waived informed consent. The purpose was to investigate nonenhanced magnetic resonance (MR) angiography with steady-state free precession (SSFP) with inversion recovery for assessing renal arteries in patients with renal transplants. Thirteen recipients of renal transplants underwent SSFP MR angiography before contrast material-enhanced MR angiography. Three stenoses (two mild, one severe) were identified at SSFP MR angiography in agreement with findings at contrast-enhanced MR angiography. There was no significant difference in image quality between the two methods. Results suggest SSFP MR angiography permits image quality of renal transplant arteries and detection of arterial stenosis comparable with those at contrast-enhanced MR angiography.
Collapse
Affiliation(s)
- Xin Liu
- Department of Radiology, Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611, USA.
| | | | | | | | | | | | | |
Collapse
|
10
|
Kalb B, Martin DR, Salman K, Sharma P, Votaw J, Larsen C. Kidney transplantation: structural and functional evaluation using MR Nephro-Urography. J Magn Reson Imaging 2009; 28:805-22. [PMID: 18821623 DOI: 10.1002/jmri.21562] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
End-stage-renal disease (ESRD) is a major health issue in the United States, and the Medicare costs of ESRD totaled nearly USD 21 billion in 2005. Renal transplantation has emerged as the treatment of choice in this patient population, providing improved quality of life and lower healthcare costs compared with other treatment options. Imaging evaluation of a graft kidney plays a critical role in the postoperative care of the renal transplant patient. In the past, diagnostic evaluation of the transplant kidney has depended upon a combination of ultrasonography, computed tomography, MRI, and biopsy, used in conjunction with the patient's clinical presentation. However, new and developing advances in MR technology has lead to the development of MR Nephro-Urography (MRNU), which provides both anatomic and functional evaluation of the kidney in a single examination. It is expected that the increasing use of MRNU will have a significant impact on the management of renal transplant patients. This review describes MRNU methodology, examines known posttransplant complications, and highlights the utility of MRNU as a comprehensive imaging examination to diagnose both surgical and medical complications of the transplant kidney.
Collapse
Affiliation(s)
- Bobby Kalb
- Emory University School of Medicine, 1365 Clifton Road NE, Building A - AT622, Atlanta, Georgia 30322, USA
| | | | | | | | | | | |
Collapse
|
11
|
Abstract
Clinical practice in paediatric nephrology is continuously evolving to mirror the research output of the 21st century. The management of antenatally diagnosed renal anomalies, urinary tract infections, nephrotic syndrome and hypertension is becoming more evidence based. Obesity and related hypertension is being targeted at primary and secondary care. The evolving field of molecular and cytogenetics is discovering genes that are facilitating clinicians and families with prenatal diagnoses and understanding of disease processes. The progression of chronic kidney disease in childhood to end-stage renal failure (ESRF) can be delayed using medical treatment to reduce proteinuria and treat hypertension. Pre-emptive living-related renal transplantation has become the treatment of choice for children with ESRF, thereby reducing the morbidity and mortality associated with peritoneal and haemodialysis. Although peritoneal dialysis, which is performed in the patient's home, is the preferred modality for children for whom there is no living or deceased donor for transplantation, home nocturnal haemodialysis is becoming a feasible option. Imaging modalities with the use of magnetic resonance and computerised tomography are continuously improving. As mortality for renal and vasculitic diseases improves, the gauntlet is now thrown down to reduce morbidity with secondary prevention of longer-term complications such as atherosclerosis and hyperlipidaemia. Clinical and drug trials in the fields of hypertension, nephrotic syndrome, systemic lupus erythematosus, vasculitis and transplantation are producing more effective treatments, thereby reducing the morbidity resulting from the disease processes and the side effects of drugs.
Collapse
Affiliation(s)
- Stephen D Marks
- Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK.
| |
Collapse
|